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In today’s world, where healthcare costs continue to rise, health insurance is an essential tool for accessing quality care. Unfortunately, underserved populations—especially children and the elderly—face significant barriers when it comes to obtaining adequate healthcare coverage.
Ensuring health insurance for underserved children and the aged is not just an equity issue; it is a critical investment in the future and the dignity of those who have served society the longest.
Insurance penetration in Nigeria remains relatively low, though the industry has experienced growth in recent years.
In 2023, the Nigerian insurance sector recorded notable progress, with a retention rate of approximately 66.7 per cent, signalling a level of stability in the market.
Life insurance businesses retained 87.7 per cent of premiums, while non-life sectors, led by oil and gas, accounted for about 54 per cent. The industry’s total assets reached N2.67tn, while capitalisation increased to N851bn.
These figures reflect the sector’s potential for growth and its solid foundation for future development.
One regulatory measure contributing to this growth is the “no-premium, no-cover” policy. Yet, despite these advancements, insurance penetration remains limited, particularly among low-income populations.
According to the National Insurance Commission, insurance penetration is less than one per cent of Nigeria’s Gross Domestic Product. Although the life insurance market shows potential, a large segment of the population remains uncaptured.
When focusing on health insurance, the situation is even more concerning. Although the National Health Insurance Scheme, introduced in 2004, aimed to provide affordable healthcare for all citizens, only about 4.2 per cent of the population had health coverage at its inception.
This figure has gradually improved, and the transformation of the NHIS into the National Health Insurance Authority in 2022 marked a significant policy shift.
Under the new framework, health insurance is now mandatory for all citizens. As of early 2022, approximately 15 million Nigerians had health insurance coverage, reflecting slow but steady progress.
Who pays for the vulnerable kids?
Health insurance coverage for children, especially those in underserved communities, remains critically low. Children from low-income families often face the greatest barriers to healthcare, with many going without routine check-ups, vaccinations, or even emergency care.
The NHIA Act identifies children, pregnant women, and the elderly as priority groups, yet penetration among these vulnerable populations remains inadequate.
“We never see food to chop, which one be health insurance,” said a mother of two children living with sickle cell.
The woman, Esther (surname withheld) who lives in Boola, a slum community in Ikosi, Ketu, Lagos told our correspondent that she has had to pay out of pocket for her daughters’ treatment.
“Look at her eyes,” she said, pointing at one of her children’s near-brown pupils. “This one body just dey hot throughout last night. Na God dey save us,” she said, gesturing towards the sky.
Another kid who shared a spot with a sleeping dog had visible rashes on his skin. His mother, who did not give her name, said he had measles, but she has had to treat him ‘the native way’.
“No near am o,” she warned this reporter. “Na measles, but we dey treat am,” she added. Asked if she had any form of health insurance, she looked at another mother and gave a loud cackle, signalling that she had none.
The challenge of extending coverage to underserved children, experts have noted, is exacerbated by issues such as low awareness, insufficient infrastructure, and a lack of funding. In rural areas, where poverty levels are higher and access to health facilities is limited, many children rely on out-of-pocket payments for their healthcare needs.
For families like Esther’s, the cost of care can be prohibitive, preventing children from receiving necessary medical attention.
According to a study published in the American Journal of Public Health, children without health insurance are three times more likely to have unmet health needs compared to those who are insured.
The long-term implications of this gap are dire. A lack of access to preventive care can lead to serious health conditions later in life, compounding the public health crisis in low-income communities.
Importance of health insurance for children
The benefits of health insurance for children are clear. Coverage ensures access to preventive services, such as well-child visits and vaccinations, which are essential for healthy development. Regular check-ups allow for the early detection of diseases and developmental issues, enabling timely interventions.
Moreover, health insurance reduces the financial strain on families, who might otherwise be forced to choose between healthcare and other essential needs, like food or housing.
According to the Kaiser Family Foundation, insured children have better educational outcomes, are more likely to complete high school, and have greater earning potential as adults.
These findings underscore the importance of expanding health insurance coverage to underserved children, as it not only benefits their health but also contributes to their long-term economic well-being.
Challenges in expanding coverage for children
One of the primary challenges in expanding health insurance for children in underserved populations is affordability.
A former Managing Director and Chief Executive Officer of African Alliance Insurance and now Managing Director of Enterprise Life Assurance Limited Nigeria, Funmi Omo, said for families living below the poverty line, even minimal premiums or co-payments could pose a significant barrier.
Other experts and HMO operators also noted that administrative hurdles, such as complex enrollment processes and low awareness of available programmes to appeal to their educational needs and class might prevent families from accessing the insurance they needed.
However, Omo stressed that insurance was for all, including the poor and the vulnerable, adding that anyone in need of insurance of any kind should approach an insurance firm to get the information they needed.
Globally, the situation is particularly challenging in developing regions like sub-Saharan Africa.
According to the World Bank, only about four per cent of children in this region have any form of health insurance.
The lack of coverage is largely a result of broader systemic issues, including underfunded healthcare systems, shortages of healthcare professionals, and the logistical difficulties of reaching remote populations.
The elderly
As people age, their healthcare needs increase, particularly due to chronic conditions like diabetes, hypertension, and arthritis. The elderly are also more likely to be hospitalised and require specialised care.
However, for many older adults—especially those from low-income backgrounds—accessing healthcare is a significant challenge.
In Nigeria, there is no universal health insurance system specifically tailored to the elderly, our correspondent learnt.
Most rely on out-of-pocket payments or financial support from family members, which is often insufficient.
A study published in the International Journal of Aging and Society found that elderly people in low-income countries were frequently denied care due to their inability to pay.
Health insurance is crucial for ensuring that the elderly receive the care they need to manage chronic conditions and maintain a good quality of life. Research shows that insured elderly individuals are more likely to receive regular check-ups, preventive care, and timely treatment for chronic illnesses.
This not only improves their well-being but also helps to prevent more costly emergency care in the future.
For instance, a study published in the Journal of Health Economics found that elderly individuals with health insurance are 20 per cent less likely to be hospitalised for preventable conditions. This highlights the importance of insurance in reducing the overall healthcare costs associated with ageing populations.
Challenges for the elderly
The primary challenge in providing health insurance for the elderly is the cost. Older adults typically have higher healthcare needs, making them more expensive to insure. As a result, insurance companies often raise premiums for older clients or exclude them from coverage altogether.
In Nigeria, the NHIA covers only a small percentage of the population, and the elderly are often left out. Without insurance, many older adults are forced to rely on family members for financial support, but this isn’t always sustainable, particularly in low-income households.
Global models for insuring underserved populations
Several global health insurance models offer potential solutions for providing affordable and comprehensive coverage to underserved populations, particularly children and the elderly.
Universal Health Coverage is a key strategy that many countries have adopted to ensure that all citizens have access to essential healthcare services without facing financial hardship.
In Ghana, the National Health Insurance Scheme has significantly increased healthcare access for vulnerable populations, particularly children, pregnant women, and the elderly. A report by the World Bank found that the NHIS has been instrumental in improving health outcomes in these groups by removing financial barriers to care.
Similarly, Brazil’s Unified Health System provides free healthcare to all citizens, including underserved children and the elderly. A study published in The Lancet noted that Brazil’s SUS has dramatically reduced healthcare disparities, particularly among the elderly, who now have better access to preventive care and treatments for chronic conditions.
These global models demonstrate the effectiveness of government-led insurance schemes in reaching underserved populations. They offer valuable lessons for countries like Nigeria, which are striving to improve health insurance coverage.
Gombe’s effort
On a more local level, innovative efforts are being made in Nigeria to extend health insurance coverage to vulnerable populations. In Gombe State, no fewer than 1,000 Almajiri children have been enrolled under the Gombe State Contributory HealthCare Management Agency’s equity program.
These children, who are traditionally left out of formal systems due to poverty and social exclusion, now have access to healthcare services they could not afford before.
Governor Muhammadu Yahaya’s administration, through initiatives like GoHealth, has shown a commitment to improving health services for the state’s most vulnerable.
By focusing on groups like the Almajiri, Gombe is setting an example of how targeted government interventions can bridge the health insurance gap for underserved children.
This local initiative echoes broader efforts on the national level, where the new National Health Insurance Act of 2022 is set to revolutionise healthcare access in Nigeria.
The NHIA has replaced the former NHIS, which failed to cover more than 10 per cent of the population. With mandatory health insurance now law, the NHIA aims to provide subsidies and insurance for vulnerable groups, including children and the elderly.
Solutions for expanding health insurance coverage
Omo explained that expanding health insurance coverage for underserved children and the elderly requires a multifaceted approach.
According to her, successful global models show that public and private partnerships, community involvement, and government-led initiatives are critical.
Other experts have also stressed that governments need to make substantial investments in UHC to ensure that all citizens, particularly children and the elderly, have access to essential healthcare services.
For instance, programmes like CHIP in the United States offer low-cost health coverage for children from low-income families. Adapting such models to Nigeria, experts have noted, could help alleviate the healthcare challenges faced by poor children.
In countries like the U.S., Medicare ensures that the elderly have access to essential health services. Developing a similar insurance scheme in Nigeria could improve access to care for the elderly, particularly in rural areas.
A developmental expert and insurance executive in the United States, Tunde Alade, added that community-based health insurance schemes have also been effective.
Alade stressed that this model, which has been widely successful in Rwanda, allows communities to pool resources and pay for healthcare. By fostering a sense of ownership and reducing the financial burden, CBHI schemes can extend coverage to underserved populations.
He added, also, that mobile Health Insurance Solutions can make health insurance more accessible. Mobile platforms that allow for enrollment and premium payments via phones can help reach underserved populations in rural areas, where banking infrastructure might be limited.
Making health insurance attractive to the poor
Several strategies can make health insurance more appealing and accessible to low-income families.
Alade stressed that the government could fully subsidise health insurance premiums for the poorest families through programmes like the Vulnerable Group Fund under the NHIA.
He said, “This will ensure that children and the elderly are automatically enrolled in health insurance plans, removing financial barriers. Public awareness campaigns can educate families on the benefits of enrolling in health insurance programs, helping increase participation rates.
“Collaborating with private health insurance providers can create affordable packages tailored to children and the elderly, covering essential services such as vaccinations and routine check-ups.”
He also noted that linking health insurance with existing social welfare programs, like cash transfers for the poor, could incentivise enrollment in health insurance schemes.
“By integrating health insurance with welfare programs, the government can ensure that underserved populations are better covered. Expanding health insurance for underserved children and the elderly is not just about improving healthcare access—it is about equity and justice.
“These vulnerable groups deserve the opportunity to live healthy, fulfilling lives, and universal health coverage is key to achieving that goal. Drawing on successful models from around the world, such as Ghana’s NHIS and Brazil’s SUS, and implementing targeted programs like CHIP and Medicare, Nigeria can make significant strides in providing health insurance to the underserved.
“Through innovative solutions like mobile health insurance platforms, community-based schemes, and government subsidies, we can bridge the gap and ensure that even the poorest and most vulnerable among us have access to quality healthcare,” he added.
Also, the Chairman of the Nigerian Insurers Association and Group Managing Director/CEO of Consolidated Hallmark Insurance, Eddie Efekoha, stressed that professionalism and better regulatory frameworks, with a concerted effort from governments, healthcare providers, and communities, could make health insurance attractive to the poor and vulnerable.
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